Download Silver Hydrosol Informed Consent Agreement

Silver Hydrosol Informed Consent Agreement
Rationale for the Use of Silver Hydrosol
Medicinal use of silver spans over the past 3 thousand years, and it is currently routinely used topically
to treat infections associated with burns and as eye drops in the newborn to prevent infectious-based
blindness. With the emergence of antibiotic-resistant germs the traditional antimicrobial uses of silver
are re-surfacing due to significant advances in nanotechnology. Present day silver-based drugs may
have far-reaching benefits when administered intravenously, orally, topically and even rectally for
specific kinds of infections.
Safety and Benefits
Currently the FDA does not recognize use of silver hydrosol. Many states do not recognize silver
hydrosol within standards of medical care. Other states such as Texas are now recognizing proper use
of silver hydrosol as allowable under standards of medical care. In view of this, no claim is being
represented that this treatment will cure disease, and the treatment must be regarded as investigational.
Silver hydrosol is currently not used by the majority of U.S. physicians, although this form of
treatment is gaining wide interest among complementary and alternative leaning medical specialists.
Colloidal silver products remain one of the major subjects of interest among web browsers looking for
alternative approaches to difficult and/or complex infections. The older authoritative medical literature
recognized a plethora of indications for the use of silver hydrosol. Silver, as silver ions, is scientifically
established to be microcidal in nature. Up to the present time, infectious disease has not yet
demonstrated germ resistance to oligodynamic silver when administered properly (i.e., in sufficient
quantities that remain below EPA guidelines (lowest observed adverse event level or LOAEL).
The Product
The medical grade silver hydrosol product used in this treatment has been specifically selected due to
its high concentration of silver ions, and its comprehensive superior quality. It is a stable, near neutral
pH, pyrogen-free, sterile solution of dilute amounts of suspended silver, also known as colloidal silver.
The recommended use of this silver product does not apply to silver preparations other than those
specifically chosen by this physician. The extremely dilute yet powerful form of this product, due to its
uniform particle size, makes it ideal to (a) minimize all known risks associated with silver
administration, while at the same time (b) maximizing the penetration (adsorption) of the silver into
infection sites within the body.
Treatment Options
Numerous conventional pharmaceutical treatments, other than the protocol being employed here, are
available to the patient. You are free to choose which type of treatment protocol you would like to
pursue at any time. You may also choose no treatment as an option. There is no harm from
discontinuing silver hydrosol therapy at any time during your course of treatment, with the exception
of interruption of your protocol which may forfeit future benefits.
Treatment Scope
This treatment protocol will involve acute and chronic infectious processes and patients who may be
immune suppressed.
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Purpose of This Treatment
Our purpose is multi-fold:
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To improve the nutritional profile of patients under immune stress,
To improve the patient’s diet;
To bolster waste elimination,
To identify any changes in the degree of the infectious processes,
To gain insight and improve techniques in order to solve the consequences of infectious
processes and to restore optimal immune function within as short a time frame as possible,
To advance the known methods within medicine for the treatment of some of the most difficult
and challenging infectious processes and immune disorders.
Treatment Duration
The treatment protocol is expected to last several days or weeks, but in certain cases the treatment
protocol may span over a few months.
Treatment Procedures
The procedure will include:
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Optimal dietary measures which include adequate fiber and purified water consumption (1/2 oz
per pound of body weight).
Standard diagnostic testing, analysis and screening, including regular laboratory work-ups
which may be ordered one or more times, such as:
o immediately prior to beginning procedure;
o at select intervals during course of treatment; and
o at completion of the treatment.
The procedure may include:
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Oral consumption of an all-natural, non-toxic nutritional supplements;
Select detoxification procedures.
Investigational Procedures of Treatment Protocol
This protocol will involve the use of intravenous silver hydrosol administration. A simple intravenous
push over 15 to 20 minutes, or a longer 3 hour intravenous drip may be administered by your physician
as deemed medically necessary at appropriate times during the course of therapy.
Foreseeable Risks or Discomforts of Treatment Protocol
This treatment protocol involves administering quantities of silver that the Environmental Protection
Agency (EPA) has determined presents no known health risks. The EPA (1998) has established a
single adverse event which may result from exposure to silver quantities vastly exceeding this
treatment protocol. This rare single adverse event involves a permanent discoloration of the skin called
argyria. In 1990, the Agency for Toxic Substances and Disease Registry (ATSDR) likewise concluded
there are no known risks or adverse events associated with silver except for argyria. Therefore, argyria
is considered a medical benign condition which involves a permanent skin discoloration.
The following patients may be at risk if they elect to undergo this protocol:
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Patients with a known allergy to silver are not candidates for this protocol. If doubt arises as to
whether a patient is indeed sensitive or allergic to silver, the physician may elect to test the
patient with an injection just under the skin of 0.2cc of the silver hydrosol to observe for a red
wheel reaction indicating the patient is indeed allergic to silver.
Patients who may be unknowingly deficient in essential nutrients, such as selenium and vitamin
E may rarely experience an uneventful, self-resolving and self-limiting swelling of the liver.
This will pass in approximately 72 hours. Please notify your physician immediately if you
notice any pressure or swelling around the upper right abdominal region.
Patients with a history of liver disease should notify the physician of this medical history so the
physician can take appropriate action to enhance liver function and liver detoxification
procedures prior to and during the course of therapy.
Patients who are pregnant and who may be experiencing pre-eclampsia or eclampsia should
notify the physician of this condition prior to undergoing any treatment with silver hydrosol.
Patients who have low adrenal function, or are taking medications which tend to induce low
potassium levels, or in patients with known potassium deficiency should notify the physician
immediately in order for the physician to institute procedures to restore normal potassium
levels prior to treatment with silver hydrosol.
Patients who have a history of sickle cell anemia must immediately notify the physician of this
condition. Careful and thorough pre-loading with select nutrients such as Vitamin E are
required if treatment is to be administered.
Patients with other forms of anemia or low blood cell counts need to immediately notify the
physician of this condition.
Large doses of silver may bring about a temporary worsening of anemia, which is then
typically associated with a rebounding toward normal blood levels after 72 hours post
treatment. More infrequently, silver administration may induce anemia. For this reason,
frequent monitoring with urine dip sticks may be ordered by your physician in order to detect
an excess loss of red blood cells.
Treatment Toxicity
There is no known lethal dose established for silver.
Jarisch-Herxheimer Events
Some patients may unknowingly have slow waste removal capacity, and/or very heavy ‘loads” of
infection. Silver hydrosol will efficiently break up infectious processes into debris. This infectious
debris needs to exit the body, and can congest a liver which is sluggish or deficient in certain nutrients
such as selenium and vitamin E. These patients may experience die-off symptoms which are nearly
always self-resolving. Die-off events are known as Jarisch-Herxheimer Events (JHEs), which may
include temporary chills and shakes (rigors), mild to moderate fever, nausea, muscle pains, joint pains,
malaise, mental fatigue and/or headaches.
80% of patients receiving silver hydrosol in therapeutic doses may experience JHEs which are
typically lessened or entirely prevented by consuming ½ gallon of organic Licorice and Green tea
daily. 17% of this patient population may experience significant and intense JHEs. However,
Licorice/Green tea typically checks such experiences. If frank JHEs arise, patients are strongly
encouraged to increase their intake of Licorice/Green tea to 1 full gallon daily. It is permissible to use
decaffeinated organic green tea if one is sensitive to caffeinated beverages. Most patients however,
enjoy the slight increase in energy from the caffeinated form of organic green tea. Simply mix one (1)
tea bag per cup of water for each type of tea respectively. For example, when making 16 cups at one
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time of the tea, simply bring one gallon of water to a boil, and place 16 licorice and 16 green tea bags
into the pot. Immediately turn off the burner. Let steep for 20 minutes and drink throughout the day.
Lemon or soy milk creamer or organic half and half may be added as desired. Raw honey is the
preferred sweetener, followed by Stevia, Mannitol or Xylitol.
Taking pre-loading doses of select nutrients along with adequate Licorice/Green tea should
easily prevent JHEs in the vast majority of patients. Nevertheless, if JHEs do arise despite these
preventative steps, (a) slowing the rate of the intravenous drip, (b) reducing the amount of the
intravenous drip, or (c) spacing out the frequency of intravenous drip may be ordered by your
physician. If JHEs persist, the good news is that all symptoms typically disappear in 72 hours or less
post treatment.
Patient Confidentiality
All patient documentation will be held in the strictest of confidence. However, if you do not object,
raw data of your results may be taken for research purposes and medical publications. At no time will
the patient’s name be used without the expressed written consent of the patient. If you have questions,
comments, or concerns, please do not hesitate to contact your physician at:
______________________________________.
Treatment Refusal
You may elect to decline our recommendation for intravenous, oral, topical, nasal, or rectal use of
silver hydrosol without incurring loss or any short of penalty.
Treatment Costs
Typical standard charges will apply. You will be charged for (a) the usual and customary office visit
fee, (b) the required laboratory diagnostic testing, and (c) nutritional supplement costs just as any other
patient would be.
In cases of financial hardship, please contact the clinic administrator for more information.
Patient Responsibility
By signing below, I agree to abide by the following recommendations:
1. Prompt communication of any symptoms of concern to my physician;
2. Compliance with physician ordered medical monitoring to insure patient safety;
3. Compliance with all dietary, hydration and nutritional supplementation recommendations to
prevent JHEs.
I confirm that I have read and understood the above and agree to the provisions of this
treatment:
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Patient’s full name (printed)
Clinic Patient’s ID
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Date: _______________, 2006
Patient’s Signature
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Physician’s (or authorized physician’s staff member) Signature
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Date: _______________, 2006